Nebraska
Medicaid Program
Provider Information
Client Copayments
The Nebraska Medicaid Program has established the following schedule of copayments for
Medicaid services:
Service |
Amount of Co-Payment |
| Chiropractic Office Visits |
$1 per visit |
| Dental Services |
$3 per specified service |
| Eyeglasses |
$2 per dispensing fee |
| Hearing Aids |
$3 per dispensing fee |
| Occupational Therapy (non-hospital based) |
$2 per specified service |
| Optometric Office Visits |
$2 per visit |
| Outpatient Hospital Services |
$3 per visit |
| Physical Therapy (non-hospital based) |
$1 per specified visit |
Physician Office Visits
Does not include visits to primary care physicians, family practice, general
practice, pediatricians, internists, and physician extenders ( including physician
assistants, nurse practitioners, and nurse midwive) providing primary care services. |
$2 per visit |
| Podiatrists Office Visit |
$1 per visit |
| Prescription Drugs |
$2 per person |
| Speech Therapy (non-hospital based) |
$2 per specified service |
Services Excluded from Copayment
The following services are excluded from the copayment requirement by federal
regulations:
- Emergency services provided in a hospital, clinic, office, or other facility that is
equipped to provide the required care. An emergency is defined as the sudden onset of a
medical condition manifesting itself by acute symptoms of sufficient severity including
severe pain that the absence of immediate medical attention could reasonably be expected
to result in placing the patient's health in serious jeopardy; serious impairment to
bodily functions; or serious dysfunction of any bodily organ or part.
- Family planning services, supplies, and drugs (such as contraceptive pills, creams,
lotions, etc.) provided to individuals of child-bearing age; and services provided by a
health maintenance organization (HMO) to individuals enrolled in the HMO. Nebraska Health
Connection Enrollment: Co-Payments are not required for clients enrolled in the Nebraska
Health Connection (Nebraska's Medicaid Managed Care program) with either an HMO or the
primary care case management network -- with the exception of prescription drugs.
Covered People
All Medicaid-eligible adults age 19 or older listed below are subject to the copayment
requirement:
- Adults eligible under the Aid to Dependent Children (ADC) program
- Adults eligible under the Aid to the Aged, Blind, and Disabled (ABBD) Program
- Adults eligible under the Refugee Resettlement Program (RRP)
- Individuals who are receiving extended assistance for former DHHS System wards
- Individuals age 19 and 20 eligible under the Ribicoff program
The client's Medicaid card will indicate whether he or she is subject to the copayment
requirement. The provider may also verify the client's copayment status by contacting the
Nebraska Medicaid Eligibility System (NMES).
Exempted People
The following individuals are exempted from the copayment requirement:
- Individuals age 18 or younger; pregnant women through the immediate postpartum period
(the immediate postpartum period begins on the last day of pregnancy and continues through
the end of the month in which the 60-day period following termination of pregnancy ends)
- Any individual who is an inpatient in a hospital, long term care facility (nursing
facility or ICF/MR), or other medical institution if the individual is required, as a
condition of receiving services in the institution, to spend all but a minimal amount of
his/her income required for person needs for medical care costs
- Individuals residing in alternate care, which is defined as domiciliaries, residential
care facilities, centers for the developmentally disabled, and adult family homes
- Individuals who are receiving waiver services provided under s 1915(c) waiver, such as
the Community-Based Waiver for Adults with Mental Retardation or Related Conditions
- The Home and Community-Based Model Waiver for Children with Mental Retardation and Their
Families; or the Home and Community-Based Wavier for Aged Persons or Adults or Children
with Disabilities
- Individuals with excess income (over the course of the excess income cycle, both before
and after the obligation is met)
- Individuals who receive assistance under the State Disability Program (SDP)
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